Is there a bias in the diagnosis of borderline personality disorder among racially minoritized patients?

Abstract

Empirical evidence documents disparities in the diagnosis of severe forms of psychopathology among racial/ethnic minority persons. However, research on diagnostic differences in personality disorders is equivocal: Some suggest higher prevalence of personality disorders among racial/ethnic minority persons, whereas other results suggest the opposite. The goal of the current study was to investigate (a) differences in the diagnosis of borderline personality disorder (BPD) in a mostly cisgender, heterosexual sample among racial/ethnic minority patients compared with non-Hispanic White patients and (b) whether any observed differences were attributable to differences in underlying maladaptive personality domains. Using data from partial hospital patients (N = 2,657), we found few differences in the diagnosis of BPD based on racial/ethnic group membership. We also conducted measurement invariance analyses of the Personality Inventory for DSM-5-Brief Form (PID-5-BF), finding evidence of invariance across White and non-White participants in these data. Any instances of diagnostic disparity were explained by group differences in maladaptive personality domains. These results provide context to the extant literature documenting mixed results about racial/ethnic differences in prevalence of personality disorders. In addition, they suggest relative specificity in BPD diagnostic bias related to sexual minority populations.

Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status

“…(Zimmerman et al, 2021). The sample partially overlaps with other investigations also utilizing the PID-5-BF in this sample (Becker et al, 2022;Rodriguez-Seijas et al, 2020a, 2020b, 2021a.…”

“…The Norwegian PID-5-BF was found invariant between Norwegian-speaking and English-speaking students (Thimm et al, 2017). In a clinical sample, the PID-5-BF items were largely invariant when comparing non-Hispanic White patients with Patients of Color (Becker et al, 2023). In addition, the PID-5 facet scales have been found invariant across clinical and nonclinical samples (Bach et al, 2018; Somma et al, 2019), across European cultures (Sorrel et al, 2021), and across sex assigned at birth (Suzuki et al, 2019).…”

“…The partial hospitalization program treatment modality consisted primarily of third-wave group behavioral interventions administered in group and individual formats daily (Zimmerman et al, 2021). The sample partially overlaps with other investigations also using the PID-5-BF in this sample (Becker et al, 2023;Rodriguez-Seijas et al, 2020a, 2020b, 2021a. However, none of these studies have examined the psychometric properties of the PID-5-BF in relation to SGM status.…”

Prison or treatment? Gender, racial, and ethnic inequities in mental health care utilization and criminal justice history among incarcerated persons with borderline and antisocial personality disorders.

“…For example, women with BPD tend to endorse more internalizing symptoms, such as suicidal ideation, self-harming behaviors, feelings of emptiness, identity disturbance, and comorbid eating disorders, whereas men with BPD tend to endorse more externalizing symptoms, such as impulsivity, substance use, and comorbid antisocial and narcissistic personality disorders (Hoertel et al, 2014; Johnson et al, 2003; McCormick et al, 2007; Sansone & Sansone, 2011; Sher et al, 2019). Furthermore, two studies of treatment-seeking persons with BPD found that POCs with BPD tended to endorse greater affective intensity, emotion dysregulation, and thoughts of interpersonal aggression and fewer self-harming behaviors relative to their White counterparts (L. G. Becker et al, 2023; Newhill et al, 2009). In contrast, a study of incarcerated persons with BPD reflected no racial differences in likelihood of violent behavior, suggesting that these differences may not generalize to carceral settings (Yasmeen et al, 2022).…”

Assessing the measurement invariance of the Personality Inventory for DSM-5 across Black and White americans.

“…Bagby et al (2022) found evidence suggesting a lack of configural invariance across WA and BA groups in the United States, interpreting a single-factor solution for the BA group, suggestive of an undifferentiated, broadly based level of demoralization. On the other hand, Becker et al (2023) examined the PID-5 across a WA and non-White group (26% Black, 44% Hispanic, 11% Asian, 19% other), finding evidence of strong invariance. Clearly, more work is needed to examine the suitability of the instrument across race in the United States, particularly for BA populations.…”